Dynamic hip screw with locked plate VRS Proximal Femoral Nail for the management of intertrochanteric fracture: A comparative study

Abstract

Introduction: Pain management in total knee arthroplasty is aimed to minimize postoperative pain and improve functional outcomes in patients. Although there are many methods used for controlling the pain there has been no consensus on most appropriate or the best protocol. Adductor canal block (ACB) has the unique advantage of providing localized analgesia but it doesn't provide pain relief to the posterior capsule, it has been postulated that IPACK (interspace between the popliteal artery and the capsule of the knee) combined with ACB will provide better pain relief than ACB alone. Materials and Methods: 60 Patients were studied in two groups. Group A had those patients with ACB+ ipack and Group B had ACB. Group A -Patient were subjected to combined ACB block with IPACK. Group B -Patient in this group were given ACB. Patient were studied for pain score VAS on Day 0 and Day 1 morning and evening, range of movement at postoperative Day 1 and distance walked on Day 1. Results: Group B had better outcome as compared to Group A. The mean VAS score for the ACB+IPACK group was less than for ACB alone at end of Day 0 and Day 1 in morning and evening. The ROM for the ACB+IPACK group was better than ACB alone and number of steps walked by patients were more in ACB+IPACK as compared to ACB alone. The statistical difference was significant when Adductor +IPACK group was compared to Adductor group for VAS, ROM and number of steps walked. Conclusion: ACB+IPACK is better mode than ACB for control of postoperative pain in patient undergoing Total knee replacement. IPACK is relatively safe and combined with adductor canal block decreases posterior pain in TKR patients.

A comparative study between dynamic hip screw and intramedullary nail fixation in trochanteric fractures

“…There was no significant difference in mean hospital stay but mean hospital stay in PFN group was less as compared to DHS group. However the overall hospital stay in DHS group was more than PFN group in all studies except in Kumar et al11 In our study the radiological union time was less in PFN group compared to DHS group, the similar observations were seen in union time of our DHS group is comparable to Walia et al and Gill et al3,10 Mean shortening of limb length discrepancy in our study was found less in PFN group then DHS group. Sharma et al reported one case each of loss of reduction, technical error, implant failure, second surgery and two case of prolonged drainage in DHS group and PFN group 13.…”

“…Our series consisted of 30 patients in each group operated with DHS and PFN, the mean age of DHS and PFN group had no statistically difference which is comparable to Sharma et al whereas the mean age is higher in studies by Gupta et al and Mathew et al 2,6,13 The male and female ratio in our study is comparable but contrary to our study Gupta et al, Gill et al and Sharma et al reported female predominance in both groups and Mathew et al reported male predominance. 6,10,13 In our study fractures were more in left side in both groups. Contrary to our study Gill et al and Kumar et al observed right side preponderance in their study.…”

“…Contrary to our study Gill et al and Kumar et al observed right side preponderance in their study. 10,11 2,3,9,10 In our study the mean surgical time was less in PFN group as compared to DHS group whereas Walia et al, Myderrizi et al and Gill et al reported overall less surgical time in both group as compared to our study. 3,9,10 The tip apex distance less than 2.5 cm is used as radiological assessment tool for proper placement of screw position to prevent screw cut outs, Z effect and reverse Z effect.…”

Comparison between Dynamic Hip Screw and Proximal Femoral Nail in Patients with Pertrochanteric Fractures

“…Author Population Union (%) PFNA DHS Kumar et al [9] Indian 100.0% 96.00% Gourishankar et al [10] Indian 100.0% 98.00% Gill et al [11] Indian 100.0% 100.0% Karn et al [12] Nepalese 100.0% 100.0% Mulay et al [13] Indian 100.0% 98.00% Yadav et al [14] Indian 100.0% 100.0% Walia et al [15] Indian 100.0% 100.0% Naikwade et al [16] Indian 99.03% 94.24% Gupta et al [17] Indian 98.75% 99.17% Khateeb et al [18] Indian 98.04% 98.04% Naushad et al [19] Indian 97.10% 82.90% Basavaraj et al [20] Indian 97.06% 94.11% Yeganeh et al [21] Iranian 96.66% 85.19% Pundkar et al [22] Indian 92.00% 100.0% Jonnes et al [23] Indian 86.70% 80.00% Kregor et al [8] American 83.00% 44.00% Suranigi et al [24] Indian 40.00% [26] Indian 6.66% 33.33% Mulay et al [13] Indian 6.00% 14.00% Harisudhan et al [27] Indian 0.00% 13.33% Walia et al [16] Indian 0.00% 11.10% Sridhar et al [28] Indian 8.33% 10.53% Mittal et al [29] Indian 0.00% 6.66% Mallikarjun et al [30] Indian 0.00% 6.66% Ujjal et al [31] Indian 0.00% 6.60% Naikwade et al [16] Indian 0.97% 5.77% Kumar et al [9] Indian 2.50% 4.35% Ranjeetesh et al [32] Indian 0.00% 4.00% Mayi et al [33] Indian 0.00% 3.13% Sharma et al [34] Indian 1.00% 2.00% Gupta et al [35] Indian 0.00% 1.25% Rohra et al [36] Indian 0.00% 1.25% Sahin et al [37] Turkey 0.00% 1.16% Matre et al [38] Norway 0.40% 0.80% Present Study Pakistan 0.0% 30.0%…”

“…However, there was controversy among the existing studies (Table 5 & 6). [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] Present study was necessitated by existing controversy and unavailability of locally published such material.…”